Study on the Assessment Process of Performing Glycerin Enemas and the Digital Removal of Feces as Practiced by Nurses for Elderly People who Require At-home Nursing Care

Abstract

　The present study clarified the assessments and nursing practice processes needed to determine whether or not visiting nurses were successful in performing glycerin enema (GE) and digital removal of feces among elderly individuals requiring home nursing. Seven visiting nurses and 17 elderly individuals requiring home nursing who were participating in a program in which the nurses helped the elderly individuals defecate were observed. In addition, a semi-structured interview was held with the nurses. According to the Modified Grounded Theory Approach method, the assessments of GE and digital removal of feces by each nurse were sorted into a flowchart. The results indicated that the nurses assessed the accumulation status and nature of stools by not only physical examinations in the order of measuring vital signs, conducting auscultation, percussion, and palpation of the abdomen, in addition to conducting a rectal examination, but also collecting information on the meals, the last date of defecation, and the amount of stool previously expelled. Following the assessment, nurses considered the likelihood of stool needing expulsion within the appointed time and then decided whether or not a GE or digital removal of feces was necessary. Furthermore, the method of performing digital removal of feces differed depending on the hardness of the stool, with digital rectal stimulation simultaneously performed depending on the hardness of the stool. The nurse explained the situations in which bleeding could be easily induced by a GE or during the digital removal of feces (i.e. situations in which adverse events were likely to occur), including when stools were hard and when a hemorrhoid was present. We need to create a nursing practice model in which nurses can practice glycerin enema and digital removal of feces while avoiding adverse events.